One hundred and thirty-nine patients with cervical myelopathy who underwent anterior decompression surgery were reviewed to determine the characteristics and surgical outcome in 26 elderly patients over the age of 65. The mean age of the aged group was 69.7 and that of the remaining 113 patients was 50.0. Extensive spur removal and interbody fusion with iliac bone graft were performed in all patients. Evaluation of clinical grades was based on the Japan Orthopedic Association Score (JOA score) on admission, at discharge and at the time of follow-up (mean 26.8 months). The improvement rate was calculated from Hirabayashi's formula at each point. Preoperatively, the mean duration of illness was longer and the mean JOA score was significantly lower in the aged group. Furthermore, low incidence of soft disc and multi-level lesions were characteristic for the aged. Final JOA score increased from 8.2 to 13.0 in the aged group, while that in the non-aged group increased from 10.5 to 14.8. These differences were statistically significant at each point. Excellent and good results which were designated as an improvement rate of 50% or more were obtained in 73.1% of the aged group, and in 79.6% of the non-aged group. Postoperative complications were slightly more frequent in the aged group, all of which, however, were dislocation of bone graft seen in 3 patients. As compared with the non-aged group, poorer surgical outcome in the aged group was attributed to preoperative poor clinical condition, long duration of preoperative symptoms, low incidence of soft disc herniation and multi-level lesions which were characteristic features for the aged patients.(ABSTRACT TRUNCATED AT 250 WORDS)